摘要: |
目的:探索尿液可溶性CD163(sCD163)对原发性IgA肾病新月体形成的预测作用。方法:回顾性分析2018年1月至2019年12月在复旦大学附属中山医院肾内科经肾活检证实为原发性IgA肾病的患者,排除合并乙型病毒性肝炎、自身免疫性疾病、肾活检前3个月内使用过免疫抑制剂的患者。根据2016年牛津病理分型,分为无新月体组和新月体形成组。测定肾活检前尿液sCD163浓度(经尿肌酐核正),分析其和患者临床表现、实验室检查结果、病理因素的关系。结果:共入选358例患者,无新月体组218例(60.9%),新月体形成组140例(39.1%)。新月体形成组患者尿液sCD163浓度显著高于无新月体组[(6.72±10.90)ng/mg vs(3.54±6.72)ng/mg,P<0.001]。尿液sCD163浓度与24 h尿蛋白定量(r=0.593,P<0.001)、新月体比例(r=0.274,P=0.001)正相关,与肾功能负相关(r=-0.241,P<0.001)。伴尿蛋白<1 g/24 h和估算肾小球滤过率(eGFR)≥ 30 mL·min-1·(1.73 m2)-1的新月体形成组患者尿液sCD163浓度均显著高于无新月体组(P<0.05)。尿液sCD163浓度判断新月体形成的ROC曲线下面积为0.715,大于eGFR(0.569,P<0.000 1)。结论:尿液sCD163在伴新月体形成的IgA肾病患者中明显升高,其浓度与蛋白尿、肾功能、新月体百分比具有良好的相关性,对IgA肾病新月体形成的预测性能优于蛋白尿、肾功能,尤其在临床轻症患者中具有一定的预测价值。 |
关键词: 可溶性CD163 IgA肾病 新月体 肾活检病理 |
DOI:10.12025/j.issn.1008-6358.2021.20210353 |
分类号:R692.3+1 |
基金项目:国家自然科学基金青年基金(81803880),上海市临床重点专科-肾内科(20000287). |
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Analysis of value of urine soluble CD163 in predicting crescent formation in IgA nephropathy |
GONG Shao-min1,2,3, JIN Shi1,2,3, SHI Yi-qin1,2,3, SHEN Zi-yan1,2,3, LIU Hong1,2,3, DING Xiao-qiang1,2,3
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1.Department of Nephrology, Zhongshan Hospital, Fudan University;2.China Shanghai Institute of Kidney and Dialysis;3.Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai 200032
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Abstract: |
Objective: To explore the value of urine soluble CD163 in predicting crescent formation in IgA nephropathy.Methods: A retrospective study was conducted in patients with renal biopsy-proven primary IgA nephropathy who were admitted to Zhongshan Hospital, Fudan University from January 2018 to December 2019. Patients who had hepatitis, autoimmune diseases, or received immunosuppressive agents less than 3 months prior to the renal biopsy were excluded. According to the 2016 Oxford classification of IgA nephropathy, patients were divided into the crescents free group and the crescents formation group. The concentration of urine soluble CD163 adjusted by urine creatinine in urine before the biopsy, and its correlation with clinical and laboratory data were analyzed.Results: Totally, 358 patients were analyzed, including 218 cases (60.9%) in the crescents free group and 140 cases (39.1%) in the crescents formation group. The concentration of urine soluble CD163 was significantly higher in the crescents formation group[(6.72±10.90) ng/mg vs (3.54±6.72) ng/mg, P<0.001]. Urine sCD163 concentration was positively correlated with 24-hour urine protein quantification (r=0.593, P<0.001) and crescent ratio (r=0.274, P=0.001), and was negatively correlated with renal function (r=-0.241, P<0.001). In the subgroup of patients with proteinuria <1 g/24 h and eGFR ≥ 30 mL·min-1·(1.73 m2)-1 with crescent formation, the urine sCD163 concentration was significantly increased (P<0.05). The area under the ROC of the urine sCD163 concentration for judging crescent formation was 0.715 which was higher than that of eGFR (0.569, P<0.000 1).Conclusions: Urine sCD163 concentration maybe increased significantly in IgA nephropathy patients with crescent formation which is closely related to the proteinuria, eGFR, and crescent ration. It may have a better performance in predicting the crescent formation in IgA nephropathy than that of proteinuria and eGFR, especially in patients with mild clinical manifestation. |
Key words: soluble CD163 IgA nephropathy crescent renal pathology |